97 articles - From Friday May 19 2023 to Friday May 26 2023
Guidelines and related publications, position statements, white papers, technical reviews, consensus statements, etc…
| Am J Gastroenterol |
American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. This document provides a comprehensive outline of the various over-the-counter and prescription pharmacological agents available for the treatment of CIC. The guidelines are meant to provide a framework for approaching the management of CIC; clinical providers should engage in shared decision making based on patient preferences as well as medication cost and availability. Limitations and gaps in the evidence are highlighted to help guide future research opportunities and enhance the care of patients with chronic constipation. |
| Gastroenterology |
American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. This document provides a comprehensive outline of the various over-the-counter and prescription pharmacological agents available for the treatment of CIC. The guidelines are meant to provide a framework for approaching the management of CIC; clinical providers should engage in shared decision making based on patient preferences as well as medication cost and availability. Limitations and gaps in the evidence are highlighted to help guide future research opportunities and enhance the care of patients with chronic constipation. |
| Hepatology |
meta-analyses and systematic reviews
| Am J Gastroenterol |
| Gastrointest Endosc |
The impact of center and endoscopist ERCP volume on ERCP outcomes: a systematic review and meta-analysis. High-volume endoscopists and centers provide higher ERCP success rates with fewer overall adverse events, especially bleeding, compared to the respective low-volume comparators. |
| Hepatology |
RCT, clinical trials, retrospective studies, etc…
| Aliment Pharmacol Ther |
Cumulative exposure to immunomodulators increases risk of cervical neoplasia in women with inflammatory bowel disease. Cumulative exposure to IM is associated with increased risk of CIN2+ in women with IBD. In addition to active counselling of IBD women to participate in cervical screening programs, further assessment of the benefit of intensified screening of women with IBD on long-term IM exposure is warranted. |
| Am J Gastroenterol |
A Narrative Review of Financial Burden, Distress and Toxicity of Inflammatory Bowel Diseases in the United States. Financial distress is prevalent among patients with IBD; financial toxicity is not well characterized. Definitions and measures varied widely. Better quantification of patient-level costs and associated impacts is needed to determine avenues for intervention. |
Impact of submucosal saline injection during cold snare polypectomy for colorectal polyps sized 3-9 mm: a multicenter randomized controlled trial. Submucosal saline injection during CSP for 3-9 mm colorectal polyps did not decrease the IRR or reduce adverse events but prolonged the procedure time. |
INCIDENCE AND PREDICTORS OF GASTRIC NEOPLASTIC LESIONS IN CORPUS-RESTRICTED ATROPHIC GASTRITIS: A SINGLE-CENTER COHORT STUDY. Patients with corpus-restricted atrophic gastritis are at increased risk for gastric cancer and T1gNET despite low-risk OLGA-scores and those aged over 60 years with corpus intestinal metaplasia or pernicious anemia seem to display a high-risk scenario. |
Management of Perianal Crohn's Disease - AJG. Most recently, the use of stem cell therapy in the treatment of perianal fistula has given new hope to the cure of perianal fistula in Crohn's disease. This review will outline the most current data in the medical and surgical management of perianal Crohn's disease. |
PATIENTS WITH INFLAMMATORY BOWEL DISEASES AND HIGHER VISCERAL ADIPOSE TISSUE BURDEN MAY BENEFIT FROM HIGHER INFLIXIMAB CONCENTRATIONS TO ACHIEVE REMISSION. In a multivariable analysis, only visceral adipose tissue % and infliximab level remained independently associated with steroid free deep remission (OR per % of VAT:0.3 [95%CI: 0.17-0.64], p<0.001 and OR per µg/ml:1.11 [95%CI: 1.05-1.19], p<0.001). CONCLUSIONSThe results may suggest that patients with higher visceral adipose tissue burden may benefit of achieving higher infliximab levels to achieve remission. |
Revised algorithmic approach to differentiate between non-specific and specific etiologies of chronic terminal Ileitis. We developed a revised algorithm and a multi-modality approach to stratify patients with chronic isolated TI into specific and non-specific etiologies with an excellent diagnostic accuracy which could potentially avoid missed diagnosis and unnecessary side effects of treatment. |
| Endosc Int Open |
Automatic textual description of colorectal polyp features: explainable artificial intelligence. CADx performance differed per CRP feature and was particularly high for surface descriptors while size and pits-distribution description need improvement. Explainable AI can help comprehend reasoning behind CADx diagnoses and therefore facilitate integration into clinical practice and increase trust in AI. |
Incomplete resection rates of 4- to 20-mm non-pedunculated colorectal polyps when using wide-field cold snare resection with routine submucosal injection. Use of CSP-SI results in lower IRRs compared to what has previously been reported in the literature for hot or cold snare polypectomy when not using wide-field cold snare resection with submucosal injection. CSP-SI showed an excellent safety and efficacy profile, however comparative studies to CSP without SI are required to confirm these results. |
Low risk of new dysplastic lesions in an inflammatory bowel disease population study with dye chromoendoscopy. The risk of dysplasia progressing to advanced neoplasia and, specifically, the risk of new neoplastic lesions after endoscopic resection of colitis-associated dysplasia, are both very low. |
Multicenter prospective evaluation of an overtube endoluminal interventional platform for colorectal polypectomy. The DBEP has the potential to provide enhanced scope stability and visualization, traction, and a conduit for scope exchange. Further prospective randomized studies are warranted. |
| Endoscopy |
Predictors of Long-term Outcomes of Endoscopic Submucosal Dissection of Early Gastric Neoplasia in the West: A Multicentre Study. This is the largest multicenter western cohort suggesting gastric ESD is safe and effective in the western setting. A quarter of our patients fell outside of the new absolute indications for ESD, suggesting that western practice involves more advanced lesions. We identified the predictors of adverse outcomes in western practice. This should inform future practice and research. |
Through-the-scope suture closure of nonampullary duodenal endoscopic mucosal resection defects: a retrospective multicenter cohort study. Prophylactic closure of nonampullary duodenal EMR defects using TTS suturing resulted in a high rate of complete closure and no delayed bleeding events. |
| Gastroenterology |
Cancer in patients with familial adenomatous polyposis - a nationwide Danish cohort study with matched controls. Despite an absolute reduction in the risk of developing cancer among FAP patients, the risk remained significantly higher than for the background population due to colorectal, pancreatic, and duodenal/small bowel cancers. |
| Gastrointest Endosc |
Comparison of outcomes of EUS-guided ablation and surveillance only for pancreatic cystic lesions: a propensity score matching study (with videos). EUS-REL was associated with a significantly lower 10-year cumulative incidence rate of BD-IPMN progression and a lower tendency of SR, while its 10-year OS and DSS were similar to those of SO for PCLs. EUS-REL may be a viable alternative to SO for managing patients with enlarging suspected BD-IPMNs or those with PCLs >3cm who are suboptimal candidates for surgery. |
Muscular injury as an independent risk factor for esophageal stenosis after endoscopic submucosal dissection of esophageal squamous cell cancer. Muscular injury was an independent risk factor for esophageal stenosis. The scoring system demonstrated good performance in predicting muscular injury during ESD. |
Validation of a Pre-endoscopy Risk Score for Predicting the Presence of Gastric Intestinal Metaplasia in a U.S. Population. A pre-endoscopy risk prediction model was validated and updated using a second U.S. cohort with robust discrimination for endoscopic GIM. This model should be evaluated in other U.S. populations to risk stratify patients for endoscopic GIM screening. |
| Gut |
Mature tertiary lymphoid structures are key niches of tumour-specific immune responses in pancreatic ductal adenocarcinomas. We provided a framework for understanding the biological role of PDAC-associated TLSs and revealed their potential to guide the selection of patients for future immunotherapy trials. |
| Hepatology |
An integrated analysis of fecal microbiome and metabolomic features distinguish Non-cirrhotic NASH from healthy control populations. Finally, we provide evidence that fecal bile acid levels may be a better discriminator of non-cirrhotic NASH versus health than either plasma bile acids or gut microbiome features. These results may have value as a set of baseline characteristics of non-cirrhotic NASH against which therapeutic interventions to prevent cirrhosis can be compared and microbiome-based diagnostic biomarkers identified. |
Cell metabolism-based therapy for liver fibrosis, repair and hepatocellular carcinoma. Metabolic reprogramming of epithelial and non-parenchymal cells is critical at each stage of disease progression, suggesting that targeting specific metabolic pathways could constitute an interesting therapeutic approach. In this review, we will discuss how modulating intrinsic metabolism of key effector liver cells might disrupt the pathogenic sequence from chronic liver injury to fibrosis/cirrhosis, regeneration and HCC. |
PROMIS Profile-29 is a valid instrument with distinct advantages over legacy instruments for measuring quality of life in chronic liver disease. Profile-29 is a valid, more efficient, well-received tool that provides improved depth of measurement when compared to SF-36 and CLDQ and, therefore, an ideal tool to measure general HRQOL in CLD. |
| J Hepatol |
Hepatic glucuronyl C5-epimerase combats obesity by stabilizing GDF15. Hepatic Glce deficiency facilitated obesity development, and decreased Glce expression further reduced hepatic secretion of GDF15, thereby perturbing lipid homeostasis in vivo. Therefore, the novel Glce-GDF15 axis plays an important role in maintaining energy balance and may act as a potential target for combating obesity. Impact and implications Evidence suggests that GDF15 plays a key role in hepatic metabolism; however, the molecular mechanism for regulating its expression and secretion is largely unknown. Our work observes that hepatic Glce, as a key Golgi-localized epimerase, may work on the maturation and post-translational regulation of GDF15. Hepatic Glce deficiency reduces the production of mature GDF15 protein and facilitates its ubiquitination, co-resulting in the aggravation of obesity development. This study may shed light on the new function and mechanism of Glce-GDF15 axis in lipid metabolism and provide a potential therapeutic target against obesity. |
Intestinal B-cells license metabolic T-cell activation in NASH microbiota/antigen-independently and contribute to fibrosis by IgA-FcR signalling. Intestinal B cells and the IgA-FcR signalling axis represent potential therapeutic targets for treating NASH. Impact and implications Nonalcoholic steatohepatitis (NASH) is a chronic inflammatory condition on the rise and can lead to hepatocellular carcinoma (HCC), the 3rd most common cause of cancer-related death worldwide. Currently, there is no effective treatment for this progressive disease that correlates with a marked risk of HCC mortality and carries a substantial healthcare burden. To date, among al the solid tumours, especially in HCC, the incidence and mortality rates are almost the same, making it crucial to find curative treatments for chronic diseases, such as NASH, which highly predispose to tumorigenesis. We have previously shown that NASH is an auto-aggressive condition aggravated, amongst others, by T cells. Therefore, we hypothesized that B cells might have a role in disease induction and progression. Our present work highlights that B cells have a dual role in NASH pathogenesis, being implicated in the activation of auto-aggressive T cells and the development of fibrosis via activation of monocyte-derived macrophages by secreted immunoglobulins (e.g., IgA). Furthermore, we could show that the absence of B cells prevented HCC development. B-cell intrinsic signalling pathways, secreted immunoglobulins, and interactions of B cells with other immune cells are potential targets in combinatorial NASH therapies against inflammation and fibrosis. |
Reprogramming of rhythmic liver metabolism by intestinal clock. Our findings establish a pivotal role of intestine clock in dictating liver rhythmicity and diurnal metabolism, and suggest targeting intestinal rhythms as a new avenue for improving metabolic health. Impact and implications Our findings establish the centrality of the intestine clock amongst peripheral tissue clocks, and associate liver-related pathologies with malfunction of intestine clock. Clock modifiers in the intestine are shown to modulate liver metabolism with improved metabolic parameters. The knowledge will help the clinicians improve the diagnosis and treatment of metabolic diseases by incorporating intestinal circadian factors. |
Roux-en-Y gastric bypass induces hepatic transcriptomic signatures and plasma metabolite changes indicative of improved cholesterol homeostasis. Our results identify specific regulatory effects of RYGB on inflammation and cholesterol metabolism. RYGB alters the hepatic transcriptome signature, likely improving liver cholesterol homeostasis. These gene regulatory effects are reflected by systemic post-surgery changes of cholesterol-related metabolites, corroborating the beneficial effects of RYGB on both hepatic and systemic cholesterol homeostasis. Impacts and implication Roux-en-Y gastric bypass (RYGB) is a widely used bariatric surgery procedure with proven efficacy in body weight management, combatting cardiovascular disease (CVD) and non-alcoholic fatty liver disease (NAFLD). RYGB exerts many beneficial metabolic effects, by lowering plasma cholesterol and improving atherogenic dyslipidemia. Using a cohort of RYGB patients, studied before and one year after surgery, we analyzed how RYGB modulates hepatic and systemic cholesterol and bile acid metabolism. The results of our study provide important insights on the regulation of cholesterol homeostasis after RYGB and open avenues that could guide future monitoring and treatment strategies targeting CVD and NAFLD in obesity. |
RSK2 inactivation cooperates with AXIN1 inactivation or ß-catenin activation to promote hepatocarcinogenesis. Our study newly demonstrated the tumor suppressor role of RSK2 and its specific synergistic effect in hepatocarcinogenesis when its loss of function is specifically combined with AXIN1 inactivation or ß-catenin activation. Furthermore, we identified the RAS/MAPK pathway as a potential therapeutic target for RSK2-inactivated liver tumors. Impact and implications This study demonstrated the tumor suppressor role of RSK2 in the liver and showed that its inactivation specifically synergizes with AXIN1 inactivation or ß-catenin activation to promote the development of HCC with similar transcriptomic profiles as found in humans. Furthermore, this study highlights that activation of the RAS/MAPK pathway is one of the key signaling pathways mediating the oncogenic effect of RSK2 inactivation that can be targeted with already available anti-MEK therapies. |
| Neurogastroenterol Motil |
Proximal esophageal impedance baseline increases the yield of impedance-pH monitoring for GERD diagnosis and is associated with heartburn response to PPI. Impedance baseline assessment in the proximal esophagus may increase the diagnostic yield of impedance-pH monitoring. Heartburn response to PPI is directly related to ultrastructural mucosal damage in the distal and in the proximal esophagus as well. |
Plenty of the editorials are available as full text through the publisher website using the provided link
| Clin Gastroenterol Hepatol |
| Gastroenterology |
| Gastrointest Endosc |
| J Hepatol |
Are patients with hepatocellular carcinoma and portal vein tumour thrombosis candidates for liver transplantation? While acknowledging the superior outcomes offered by LT for patients with portal vein tumour thrombosis, the counterargument is that expected survival in such patients is still below accepted thresholds for LT and, indeed, the levels achieved for other patients who receive transplants beyond the Milan criteria. Based on the available evidence, it seems too early for consensus guidelines to recommend such an approach, however, it is hoped that with higher quality evidence and standardised downstaging protocols, LT may soon be more widely indicated, including for this population with high unmet clinical need. |
Artificial intelligence, machine learning, and deep learning in liver transplantation. Although AI shows promise in medicine, there are limitations to its clinical deployment which include dataset imbalances for model training, data privacy issues, and a lack of available research practices to benchmark model performance in the real world. Overall, AI tools have the potential to enhance personalised clinical decision-making, especially in the context of liver transplant medicine. |
Donation after circulatory death: Novel strategies to improve the liver transplant outcome. For each technique, clinical studies reporting on the transplant outcome are described, together with a discussion on the possible protective mechanisms involved and the functional criteria adopted for graft selection. Finally, we review multimodal preservation protocols involving a combination of more than one perfusion technique and potential future directions in the field. |
Early liver transplantation for severe acute alcohol-related hepatitis after more than a decade of experience. However, there is still high variability in access to LT for patients with severe alcohol-related hepatitis, mainly due to a persistent overemphasis in the pre-LT evaluation on duration of pre-transplant abstinence and the stigma that patients with alcohol-related liver disease often experience, leading to marked inequity of access to this potentially lifesaving procedure and negative health outcomes. Therefore, there is an increasing need for prospective multicentre studies focusing on pre-transplant selection practices and on better interventions to treat alcohol use disorder after LT. |
Evaluation of living donors for hereditary liver disease (siblings, heterozygotes). No mortality or morbidity related to recurrence of metabolic diseases has been observed with heterozygous donors, except for certain relevant cases, such as ornithine transcarbamylase deficiency, protein C deficiency, hypercholesterolemia, protoporphyria, and Alagille syndrome, while donor human leukocyte antigen homozygosity also poses a risk. It is not always essential to perform preoperative genetic assays for possible heterozygous carriers; however, genetic and enzymatic assays must hereafter be included in the parental donor selection criteria in the aforementioned circumstances. |
Evaluation of recipients with significant comorbidity - Patients with cardiovascular disease. Further diagnostic work-up is undertaken based on the results of the baseline evaluation and may include a coronary computed tomography angiography in patients with cardiovascular risk factors. The evaluation of potential LT candidates for cardiovascular disease requires a multidisciplinary approach, with input from anaesthetists, cardiologists, hepatologists and transplant surgeons. |
Immunobiology of Cholangiocarcinoma. Broad strategies to re-equip the immune system include blockade of suppressive immune cell recruitment to priming cytotoxic effector cells against tumor antigens. While immunotherapeutic strategies are gaining traction in the treatment of cholangiocarcinoma, there is a long road of discovery ahead in order to make meaningful contributions to patient therapy and survival. |
Issues in multi-organ transplantation of the liver with kidney or heart in polycystic liver-kidney disease or congenital heart disease: Current practices and immunological aspects. Herein, we review the indications and outcomes of simultaneous liver-kidney transplantation for polycystic liver-kidney disease, and discuss the indications, timing and procedural aspects of combined heart-liver transplantation. We also summarise the evidence for, and potential mechanisms underlying, the immunoprotective impact of liver allografts on the simultaneously transplanted organs. |
Liver transplantation immunology: Immunosuppression, rejection, and immunomodulation. Currently, the evidence regarding the efficacy and safety of immune checkpoint inhibitors in liver transplant recipients is limited and cases of severe allograft rejection have been reported. In this review, we discuss the clinical relevance of alloimmune disease, the role of minimisation/withdrawal of immunosuppression, and provide practical guidance for using checkpoint inhibitors in liver transplant recipients. |
Liver transplantation in the patient with physical frailty. g., cognition, emotional, psychosocial) also need to be addressed in patients on the transplant waitlist. Recent advances in our understanding of the underlying mechanisms of sarcopenia and contractile dysfunction have helped identify novel therapeutic targets. |
Machine perfusion of the liver and bioengineering. This review first discusses current strategies to improve the quality of donor livers, and secondly reports on bioengineering techniques to design optimised organs during machine perfusion. Current practice, as well as the benefits and challenges associated with these different perfusion strategies are discussed. |
Mini-Review for Journal of HepatologyTherapeutic opportunities for the treatment of NASH with genetically validated targets. The identification of these variants has allowed insight into the metabolic pathways causing FLD and to identify therapeutic targets to treat the disease. In this mini-review we will examine the therapeutic opportunities derived from genetically validated targets in FLD, including PNPLA3 and HSD17ß13, where oligonucleotide-based therapies are currently being evaluated in clinical trials for the treatment of non-alcoholic steatohepatitis (NASH). |
Post-liver transplantation patient experience. Patient HRQOL improves after transplantation, but it may not improve to that of age-matched cohorts. Understanding patient experience and the factors that contribute to it, including physical and psychological health, immunosuppression and medication adherence, return to employment or school, financial burden, and expectations, helps when thinking creatively about potential interventions to improve HRQOL. |
Should patients with acute-on-chronic liver failure grade 3 receive higher priority for liver transplantation? Based on the severity of his liver disease and multiorgan failure, the patient is at an exceedingly high risk of death without LT. Is it appropriate to perform LT in such a patient? |
Statistical perspectives on using hepatocellular carcinoma risk models to inform surveillance decisions. However, although numerous risk models have now been published, few are being used in routine care to inform HCC surveillance decisions. In this article, we discuss methodological issues stymieing the use of HCC risk models in routine practice - highlighting biases, evidence gaps and misconceptions that future research must address. |
Transplantation for metastatic liver disease. This has been followed by larger studies, and prospective trials are ongoing to quantify the potential benefits of liver transplantation over palliative chemotherapy. This review provides a critical summary of currently available knowledge on liver transplantation for neuroendocrine and colorectal liver metastases, and highlights avenues for further study to address gaps in the evidence base. |
misc publications eg case reports, tools of the trade, images of the month, etc…
| Am J Gastroenterol |
| Endoscopy |
| Gastroenterology |
| Hepatology |
Letters to the editors and authors’ replies
| Clin Gastroenterol Hepatol |
| Gastroenterology |
| Gastrointest Endosc |
| Gut |